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• AMERICAN VALLEJO 67679 <br /> WASTE ®IL, INC, <br /> Invoice Number: <br /> P.0. Box 340 • Delhi, CA 95315 <br /> PH. 1-6RO-732-4645 • FAX 209-668-3880 i DEC 27 pK 1: 49 <br /> EPA. CAL000827878 <br /> L TPT DEPAR TNFNFnvoice Date: <br /> BILL TO: JOB SITE: <br /> IPPPFiRSTATE 1 OLLI`9I014 DIVISON INTERSTATE; COLLISION UIVISON <br /> P,() BOIX 6463 641 S. HkRRIS014 ': SCOTT <br /> STOt:KTON, CA 9b.90 i STOCKTf1N, CA 55206 <br /> f 1,10. SC-I <br /> Phone Customer P.O. Payment Terms ' ' -'Eli <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE' <br /> USED OIL NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> TRINITY HEAVY DUTY PREMIX <br /> RECYCLED ANTIFREEZE I N/A <br /> u <br /> NON HAZARDOUS WASTE LIQUID 7 6 G 00 . 1_ cs�J <br /> TRUCK TIME ` N/A <br /> 1G'REASWEEP N/A <br /> so 60 h nn <br /> MI_:l., SUR CHARLIE 15 00 <br /> I hereby certify that I have not mixgd this waste with any other waste,that the total halides are less than 1000 P.P.M.;and that <br /> the waste does not contain any P.C. :s. 1 further agree to accept the additional charges for legal disposal if this waste is over TO,fAL. -' - <br /> 1000 P.P.M.total halides,of contai s an P.C.B.'s. <br /> DRIVER GENERATOR AUTHORIZE <br /> SIGNATURE I SIGNATURE/SIGNATURE - / <br /> TERMS: INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE. CUST MER XGREWTO PAY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be transported to a facility that is required to comply <br /> with federal regulations applicable to management of used oil,but that isrrt�otre9uired to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities. California facilities that handle or process meed oil are required.to meet those more stringent requirements, and some out-of- <br /> state facilities that process used oil also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br /> accidental releases. It is lawful to send used oil to out-of-state facilities that com&ly UI-with�ederal used oil management standards and not these more <br /> stringent requirements. . T <br /> This notification is for information purposes only. r.. <br /> Driver signed Date Ge gator tnetl Date <br /> By signing the invoice the generator certifies that-the gd erator hB)'; stablished a program to reduce the volume or quantity and toxicity of the hazardous <br /> waste to the degree,as determined by the generator,10-be econor;city practicable. <br /> By both parties signing this invoice it will serve as an agreement that American Valley will submit confirmations for(certain waste streams)to the generator <br /> that their waste has been transported to a license treatment or transfer facility. - <br /> DISPOSAL/ RECYCLING FACILITY <br /> O RIVERBANK OIL TRANSFER O RAMOS ENVIRONMENTAL SERVICES <br /> 5300 CLAUS ROAD• RIVERBANK, CA 95367 1515 SOUTH RIVER ROAD•W. SACRAMENTO, CA 95691 <br /> 209-863-8181 •EPA#CAL000190816 916-371-5747• EPA#CAD044003556 <br /> MPC 0a <br />